Missouri Southern State University Student-Athlete Questionnaire

This form is intended for CURRENT MISSOURI SOUTHERN STUDENT ATHLETES ONLY. If you are a prospective student athlete and want a coach to contact you, you can fill out the individual sports' forms found HERE. Please note that unless you fill out the correct form, your coach will not receive it. Thanks.

Name E-Mail

Preferred Name (if different from above)

Sports at MSSU

Major

Position to be played

Height Weight

Dominant Hand

Your Address at MSSU

Your Phone Number at MSSU

Date of Birth

City and State of Birth

Permanent Address

Previous College (if any)

High School and City where it was located

HS Graduation Year Mascot

Name the Sports you played in High School - List the coaches' FIRST AND LAST names

1. Coach Name Position/Event Letters Earned Years Started
2. Coach Name Position/Event
Letters Earned Years Started
3. Coach Name Position/Event
Letters Earned Years Started
4. Coach Name Position/Event
Letters Earned Years Started

List any honors/key statistics for each varsity year (indicate which sport referring to):

List any school records set:

List any team championships that you helped your school to:

List any honors/key statistics/records etc. set while playing for a club sport

If you are a transfer, please list any stats and achievements (ie. All-Conference/All-Region/All-American) and honors you received at your previous school.
Father's Name
Occupation
Alma Mater Graduation Year

Mother's Name
Occupation
Alma Mater Graduation Year

If married, please list spouse's name (maiden), how long you've been married and any children's names and ages:

List any relatives were are or were college or professional athletes. (please indicate name, relationship to you and when or where they played)

List your home town newspaper and contact information

By clicking the submit button below, you signify you authorize the sports information department at Missouri Southern State University to use all of the information listed above, as well as photographs and any other present or future information about me as a student-athlete at MSSU for sports publicity and information purposes. I grant this authorization as a waiver to my rights under the Education Ammendment of 1972 to restrict the release of information to persons outside the University. I also acknowledge personal information such as phone numbers, addressess and social security numbers are for office use only.